Kenya leads the way as US shifts African health aid to bilateral deals
When Kenya's President William Ruto signed a landmark health agreement with US Secretary of State Marco Rubio in Washington last December, it marked the first tangible result of a major shift in American foreign aid. The deal, worth $2.5 billion (£1.9 billion), is the first government-to-government agreement under a new US strategy that replaces traditional donor-NGO models with direct partnerships with national governments. But as Ruto's government celebrated the framework's approval last month, the broader transition has sparked resistance, legal challenges, and concerns across the continent.
From USAID to bilateral agreements
The new approach follows the Trump administration's decision to dismantle the US Agency for International Development (USAID), which had been the primary channel for American health assistance abroad. Accused of wastefulness, USAID's closure had a severe impact on health programmes in several African countries that relied on its funding. In its place, the State Department has introduced a strategy that requires recipient governments to contribute financially and work toward self-reliance in their health systems.
Under the new model, the US provides funding directly to government institutions rather than through NGOs. For Kenya, this means a US investment of $1.6 billion (KSh208 billion) over five years, with the Kenyan government pledging an additional $850 million. The framework aims to strengthen collaboration on HIV, malaria, and tuberculosis prevention and control, and to improve disease surveillance, laboratory networks, and digital health systems. It also facilitates the absorption of more than 13,000 US-supported health workers into Kenya's public health workforce.
Secretary Rubio, who signed the agreement alongside Kenyan Prime Cabinet Secretary Musalia Mudavadi, expressed hope that it would be the first of many. "We hope to sign, I don't know, 30, 40, how many? Fifty? Well, this is number one," he said. The administration believes that partnering directly with national governments will reduce dependency and cut overhead costs that previously went to NGOs.
However, the deal with Kenya, valued at $2.5 billion in total, has not gone unchallenged. Activists went to court to block it, citing concerns about privacy and data access. A Kenyan court initially suspended the agreement over such concerns, though cabinet ministers ultimately approved it last month.
Key claims and conditions
At the heart of the new strategy is a push for "self-reliance" in recipient countries. The State Department argues that traditional donor-NGO relationships created dependency, led to parallel delivery systems, and wasted aid dollars on overhead costs. Secretary Rubio told a congressional committee, "Our aid to those countries will not just be dollars distributed to an NGO that will then go into the country and impose programs."
However, the conditions attached to the new deals have drawn criticism. According to reporting by BBC — World, the agreements include an explicit promise to prioritize US pharmaceutical and medical firms. Zambia has publicly criticized the linking of health funding to US economic interests, particularly access to critical minerals. The US has also withdrawn HIV/AIDS funding from South Africa over disputes regarding treatment for the Afrikaner community.
Privacy concerns have also been raised. A Kenyan court initially suspended the deal over worries about US access to patient data and biological pathogens, which critics fear could be used for pharmaceutical development. Activists in Kenya went to court to block the agreement, though cabinet ministers eventually approved it last month.
The broader picture
Despite the resistance, the US is pressing ahead. As of mid-May, 32 countries had accepted the new health Memoranda of Understanding (MOUs), according to BBC — World. The strategy aims to build durable, self-reliant health systems by shifting responsibility to recipient governments.
However, the approach has been questioned in the context of ongoing health emergencies. The Ebola outbreak in the Democratic Republic of Congo has highlighted the risks of aid cuts and the limitations of a bilateral approach, according to BBC — World. Cuts to USAID led to layoffs of health workers and weakened outbreak response capabilities, raising alarm among health experts.
Kenya's perspective
AllAfrica's coverage of the Kenya agreement emphasizes the positive aspects of the deal. The framework aims to strengthen collaboration in preventing and controlling HIV, malaria, and tuberculosis, while also improving disease surveillance, laboratory networks, and digital health systems. A key component is the absorption of more than 13,000 US-supported health workers into Kenya's public health workforce.
President Ruto said the agreement "adds momentum" to Kenya's universal health coverage efforts, focusing on modern equipment, efficient delivery of health commodities, and enhanced disease surveillance. The deal is seen as a step toward leaving no Kenyan behind in accessing quality healthcare.
However, the Ebola outbreak in the Democratic Republic of Congo has underscored the risks of the new approach. Health experts have pointed to the outbreak as evidence that aid cuts and a reliance on bilateral agreements may weaken the collective capacity to respond to disease outbreaks, according to BBC — World.
Differing views
AllAfrica's coverage presents the Kenya-US agreement in a positive light, emphasizing the strengthening of cooperation in fighting HIV, malaria, and tuberculosis, and the integration of more than 13,000 US-supported health workers into Kenya's public health system. The outlet frames the deal as a step toward universal health coverage.
In contrast, BBC — World's reporting is more critical, highlighting the transactional nature of the new aid model. It notes that the US has withdrawn HIV/AIDS funding from South Africa over policy disputes and that the Ebola outbreak in the Democratic Republic of Congo has underscored the risks of aid cuts and the limitations of the bilateral approach. The outlet quotes Secretary Rubio's hopes of signing many such agreements, but also records the skepticism from countries like Zambia.
As the bilateral model expands, African nations are weighing the benefits of direct government partnerships against the strings attached. For Kenya, the deal is a landmark. For others, it may be a cautionary tale.